[Antibiotic therapy of severe community-acquired pneumonia].

Combined antibiotic therapy, including the use of intravenous cefotaxime (a beta-lactam) and azithromycin (a macrolide) was shown advantageous from both clinical and economic viewpoints in the treatment of severe community-acquired pneumonia.

Using cost of infection as a tool to demonstrate a difference in prophylactic antibiotic efficacy: a prospective randomized comparison of the pharmacoeconomic effectiveness of ceftriaxone and cefotaxime prophylaxis in abdominal surgery.

The purpose of this study was to test the hypothesis that cost, as well as frequency of infection, could be used to demonstrate a difference in the performance of prophylactic antibiotics. In a prospective, randomized, double-blind study, 1013 patients undergoing abdominal surgery were given 1 g of intravenous ceftriaxone (R) or cefotaxime (C) at induction of anesthesia, and an additional 500 mg of metronidazole for colorectal surgery. Infection was checked for during the hospital stay and at 30 days postoperatively. The inpatient, outpatient, and community costs of infection were prospectively collected. The frequency of wound infection for appendectomies when additional metronidazole was not administered was greater with cefotaxime (R 6%, C 18%, p < 0.05), but the cost of infection was the same (average cost R $994 +/- SD $1101, C $878 +/- $1318). For all other procedures, the frequency of wound infection was similar (R 8%, C 10%), but the cost was less with ceftriaxone (R $887 +/- $1743, C $2995 +/- $6592, p < 0.05). Ceftriaxone decreased the frequency but not the cost of chest and urinary infection (frequency R 6%, C 11%, p < 0.02, cost R $1273 +/- 2338, C $1615 +/- 4083). Differences in both the frequency and cost of all infection are also presented. Ceftriaxone decreased either the frequency or the cost of different postoperative infections. The cost of infection can increase the discriminatory power of trials comparing antibiotic effectiveness.

[Cost-effectiveness analysis of ceftriaxone and cefotaxime in the treatment of community-acquired pneumonia]. / Estudio de costo-efectividad de ceftriaxona y cefotaxima en el tratamiento de neumonía adquirida en la comunidad.

OBJECTIVE: To assess the cost-effectiveness ratio of ceftriaxone and cefotaxime to treat moderate to severe community acquired pneumonia (CAP). METHODS: A clinical trial was done in five hospitals of the Instituto Mexicano del Seguro Social, at the metropolitan area of Mexico City. Ceftriaxone and cefotaxime were compared to treat moderate to severe CAP, and the costs of purchasing, preparation, administration, hospitalization, and therapeutic success were quantified. Cost-effectiveness ratio was calculated, and sensitivity analysis and incremental analysis were done. RESULTS: The main isolated germs were Streptococcus pneumoniae (23.6%) and Staphylococcus aureus (18.5%). Most of the microorganisms were sensitive to ceftriaxone, ceftazidime, and cefotaxime, and were resistant to penicillin, ampicillin, and erythromycin. Therapeutic success was 98% in the ceftriaxone group and 83% in the cefotaxime group (p = 0.0091). Cost-effectiveness ratio for per cent unit of success was $19,458.62 Mexican pesos in the ceftriaxone group and $29,218.08 in the cefotaxime group. Sensitivity analysis showed consistently a lower cost-effectiveness ratio in the ceftriaxone group. Incremental analysis based on the treatment of 55 patients showed that using ceftriaxone instead of cefotaxime resulted in saving $35,170.79 per each additional cured patient. CONCLUSIONS: Ceftriaxone has a lower cost-effectiveness ratio than cefotaxime to treat patients with CAP and bad prognosis criteria requiring hospitalization.

Sequential antimicrobial therapy: treatment of severe lower respiratory tract infections in children.

Although there have been a number of studies in adults, to date there has been little research into sequential antimicrobial therapy (SAT) in paediatric populations. The present study evaluates the impact of a SAT protocol for the treatment of severe lower respiratory tract infection in paediatric patients. The study involved 89 paediatric patients (44 control and 45 SAT). The SAT patients had a shorter length of hospital stay (4.0 versus 8.3 days), shorter duration of inpatient antimicrobial therapy (4.0 versus 7.9 days) with the period of iv therapy being reduced from a mean of 5.6 to 1.7 days. The total healthcare costs were reduced by 52%. The resolution of severe lower respiratory tract infection with a short course of iv antimicrobials, followed by conversion to oral therapy yielded clinical outcomes comparable to those achieved using longer term iv therapy. SAT proved to be an important cost-minimizing tool for realizing substantial healthcare costs savings.

Comparison of 5-day and 10-day cefixime in the treatment of acute exacerbation of chronic bronchitis.

The focus of a multicenter trial conducted in Germany was to investigate whether a 5-day short course of cefixime 400 mg was equivalent to a 10-day standard therapy of cefixime 400 mg in the treatment of acute exacerbation of chronic bronchitis (AECB). In the 167 patients who were evaluated, on day 11 following treatment with once-daily oral cefixime resulted in clinical success in 91 and 89% of cases in the 5-day and 10-day treatment groups, respectively. At days 6, 11 and 30 after treatment there was no statistically significant difference between the 2 dose groups (p < 0.01). Bacteriological equivalence was also demonstrated. Gastrointestinal adverse events showed a tendency to occur less frequently in the 5-day group, but the difference was not significant. The results indicate that a short course therapy is equivalent in efficacy to the standard 10-day therapy in patients with AECB, and may thus offer cost advantages.

Cost-effectiveness of ceftriaxone in the treatment of community-acquired pneumonia in adult hospital patients. A pharmaco-economic study based on a meta-analysis.

OBJECTIVES: A retrospective analysis was conducted to assess the cost-effectiveness of four intravenous antibiotic treatment regimens in the treatment of severe community-acquired pneumonia (CAP) in adults in a private hospital setting. The study compared some third-generation cephalosporin regimens with a second-generation cephalosporin and an amoxicillin/clavulanic acid (co-amoxiclav) regimen to investigate published South African treatment guidelines from a pharmaco-economic point of view. METHOD: A pharmaco-economic model of local costs, from a payer perspective, was based on the results of a meta-analysis of clinical papers from peer-reviewed journals. The study compared intravenous (i.v.) ceftriaxone (2 g once daily), cefotaxime (i.v. 2 g 3 times a day), cefuroxime (i.v. 750 mg 3 times a day, followed by 500 mg orally 3 times a day) and amoxicillin/clavulanic acid (1.2 g intravenously 3 times a day, followed by 625 mg orally 3 times a day) [corrected]. RESULTS: An analysis of the odds ratios (ORs) of all two-way comparisons indicated that ceftriaxone ensured significantly higher probabilities of successful outcomes than the other antibiotic treatment regimens (ORs in the order of two were indicated). The pharmaco-economic results suggested that the ceftriaxone treatment regimen was the most cost-effective in the hospital treatment of CAP in adult patients. These results proved to be robust across sensitivity analyses for success rates and treatment days. A sensitivity analysis testing the assumption that patients could be discharged once the oral treatment was initiated indicated that the amoxicillin/clavulanic acid and cefuroxime treatment arms were more cost-effective. The clinical validity of such an assumption is questionable. CONCLUSION: Despite the conservative approach followed in terms of ceftriaxone data, both the clinical results and cost-effectiveness supported the use of ceftriaxone in the treatment of CAP in adults in the hospital setting.

Cost comparison of single daily i.v. doses of ceftriaxone versus continuous infusion of cefotaxime.

The costs of administering ceftriaxone 1 g in a once-daily 30-minute infusion were compared with the costs of administering cefotaxime 2 g/day (with an additional 1 g given on day 1) by continuous intravenous infusion. Time and motion studies were conducted to determine the pharmacy and nursing labor required to prepare and administer the intermittent and continuously infused antimicrobials. Mean times were multiplied by the mean New England hourly wage for pharmacy technicians, pharmacists, and nurses to determine the total labor costs of each regimen. Hospital acquisition costs of items used in preparing antimicrobial doses for administration by each method were also compared. Wholesale acquisition costs of the two drugs were used in the analysis. Labor costs were higher for the continuously infused antimicrobial because of the additional nursing time required for monitoring. Supply costs were greater for continuous infusion. Drug acquisition cost was the major component of the overall cost of therapy and was lower for continuous infusion. A cost analysis showed that continuous i.v. infusion of cefotaxime 2 g/day was less expensive from day 2 onward than intermittent daily i.v. doses of ceftriaxone 1 g.

[Cost-effectiveness comparative study of ceftriaxone verus cefotaxime in the treatment of complicated urinary infections]. / Estudio comparativo coste eficacia ceftriaxona versus cefotaxima en el tratamiento de las infecciones urinarias complicadas.

Prospective, randomized, multicenter study in 267 patients with complicated urinary infection from 9 hospitals nationwide. Drug treatment was either Ceftriaxone 1 g once daily parenterally or Cefotaxime parenteral 1 g 8 hourly for a minimum of 7 days. Patients were clinically, analytically and microbiologically evaluated before and after treatment to assess the efficacy and tolerance of both drug products. To evaluate treatment cost, we used the price of both drugs and the material required for their administration (syringe and disposable needle). 119 patients were excluded from the cost-efficacy evaluation and 148 remained in the study (75 assigned to treatment with Ceftriaxone and 73 to Cefotaxime). Clinical efficacy of treatment was 93% and 87.6% for Ceftriaxone and Cefotaxime respectively (p > 0.05). Cost per patient was 27,347 pesetas for Ceftriaxone and 34,490 for Cefotaxime (p < 0.05).

Pharmacoeconomic aspects of antibacterial treatment with cefotaxime.

Pharmacoeconomics is a relatively new discipline, which is becoming increasingly useful in the current climate of medical advances that continue despite limited access to healthcare resources. Pharmacoeconomics may be used as a tool, assisting healthcare decision makers to select clinically beneficial therapies and weigh clinical gain against expenditure. Cefotaxime has been shown in many studies to be a cost-effective antibiotic agent, its monetary value being augmented by its use in low dose, low frequency regimens. This cost-effectiveness, combined with a maintained broad spectrum of antibiotic activity, low propensity for selecting resistant bacterial strains and high therapeutic index, makes cefotaxime a suitable antibiotic agent in many indications involving mild-to-moderate infections by susceptible organisms.

[The use of cefotaxime on patients admitted to the internal medicine service of a general hospital. An analysis from the viewpoint of health economics]. / Empleo de la cefotaxima en pacientes ingresados en el Servicio de Medicina Interna de un hospital general. Un análisis desde el punto de vista de la economía de la salud.

Cefotaxime is a widely employed antibiotic in hospital practice, leading to an important economical cost. We analyse the adequacy of the indications of cefotaxime in our Internal Medicine Unit along a two month period. The records of the 54 patients treated with cefotaxime along a two month period were retrospectively reviewed to establish the adequacy of the prescriptions by checking them with a list of indications based on widely used bibliographical sources. Cefotaxime prescription was considered inadequate because of its inefficiency in 15 out of the 54 patients studied (28%). They were all patients admitted because of bronchitic relapses of chronic obstructive lung disease ("COLD") without radiological evidence of pneumonic consolidation. We calculate that using a more efficient antibiotic alternative could lead to a decrease of a 3.6 to 7.53% in the total pharmaceutical expenses of our unit along the study period. We conclude that the unnecessary routine use of cefotaxime may lead to an avoidable important increase in sanitary costs.

Effect of replacing cefotaxime with ceftizoxime in a hospital where penicillin-resistant pneumococcal disease is prevalent.

Ceftizoxime and cefotaxime demonstrate very similar activities in vitro against a broad range of bacteria. To reduce costs, our hospital pharmacy implemented an automatic substitution policy whereby ceftizoxime was dispensed and administered whenever cefotaxime was ordered. This policy was modified when penicillin-resistant Streptococcus pneumoniae isolates were found to be markedly less susceptible to ceftizoxime than to cefotaxime, of concern considering the prevalence and virulence of this pathogen. We compared clinical findings among 179 adult patients treated with ceftizoxime for any indication during the substitution months with 200 patients treated with cefotaxime during the previous year. The ceftizoxime group had a shorter mean length of stay, which paralleled a hospital-wide trend toward more efficient discharge planning. After adjusting for this trend, we observed no significant difference in duration of study drug, number of other intravenous antibiotics, likelihood of receiving additional antibiotics after study drug completion, or patient survival. Fortuitously, no penicillin-resistant pneumococcal infections were documented in ceftizoxime-treated patients. This study suggests that cefotaxime and ceftizoxime are comparable. The choice of one versus the other may be dictated by price, provided ceftizoxime is not used for proven or suspected penicillin-resistant pneumococcal infections.

A cost-effectiveness evaluation of 3 antimicrobial regimens for the prevention of infective complications after abdominal surgery.

OBJECTIVE: To measure the cost and effectiveness of 3 established antimicrobial regimens for the prevention of infective complications after abdominal surgery. DESIGN: A prospective randomized trial was performed involving a total of 1070 patients undergoing abdominal surgery. SETTING AND PATIENTS: All patients having upper gastrointestinal tract, colorectal, appendiceal, or biliary surgery at a major teaching hospital in Melbourne, Australia, were considered for entry into the study. INTERVENTIONS: Patients were randomized prior to surgery to receive a single dose of cefotaxime sodium (1 g), ticarcillin plus clavulanic acid (3.1 g), or ceftriaxone sodium, (1 g). All drugs were given intravenously at the start of anesthesia. MAIN OUTCOME MEASURES: Rates of major wound infections, minor wound infections, other wound problems, and other infective complications. The acquisition and administrative costs of the drugs used and the costs of the infective complications were measured. RESULTS: A Total of 1070 patients were entered into the study. Major wound infections occurred in 21 patients (2.0%). Twenty-five patients (2.3%) developed a minor wound infection. Other infective complications developed in 107 patients. There were significantly fewer minor wound infections in the ceftriaxone-treated group as compared with the other 2 groups. There was no differences in the frequency of major wound infections, other wound problems, or other infective complications. The acquisition costs of cefotaxime and ticarcillin plus clavulanic acid were less than those of ceftriaxone. The estimated cost of treating the infective complications in the group of patients who received ticarcillin plus clavulanic acid ($128,039) was greater than the cost associated with the groups being treated with cefotaxime ($91,243) or ceftriaxone ($96,095). CONCLUSIONS: The study indicates that each of the 3 regimens was associated with highly satisfactory control of postoperative infective complications after abdominal surgery. On the basis of the estimated costs of infective complications, cefotaxime and ceftriaxone appear equally effective for the prevention of infective complications after abdominal surgery. Acquisition costs for cefotaxime were lower and it is recommended as the preferred agent on this basis.

Cost-effectiveness decision analysis of intramuscular ceftriaxone versus oral cefixime in adolescents with gonococcal cervicitis.

STUDY OBJECTIVE: We compared the cost-effectiveness of two single-dose treatment strategies for adolescents with uncomplicated Neisseria gonorrhoeae cervicitis. METHODS: We used a cost-effectiveness decision- analysis model to compare the two methods: the standard, ceftriaxone 125 mg given by IM injection; and an alternative, cefixime 400 mg given orally. The effect of the costs associated with the risk of accidental needlestick during IM administration was also evaluated. Key baseline assumptions (with ranges, when tested) were from the literature or costs to our hospital. These included ceftriaxone, $8.60 per dose; cefixime, $4.67 per dose; ceftriaxone efficacy, 98% (range, 94.9% to 100%); cefixime efficacy, 97% (94.1% to 100%); and a 15% probability of pelvic inflammatory disease (PID) related to failed treatment. We included costs for PID necessitating hospitalization, disseminated gonococcal infection, infertility, and ectopic pregnancy. Assumptions related to accidental needlestick included the rate of needlesticks with the disposable syringe, 6.9 per 100,000 injections (range, 0 to 69); cost of accidental needlestick to hospital; risk of HIV seroconversion after needlestick exposure to HIV-infected blood, .36% (range, 0% to .86%); rate of HIV infection in 15- to 19-year-olds attending sexually transmitted diseases clinics, .4% (range, 0 to 5); and lifetime treatment costs for a person with HIV. RESULTS: At baseline values the model favored ceftriaxone ($45 per patient) or cefixime ($59 per patient). However, over the range of efficacy of both drugs, two-way sensitivity analysis revealed no consistent cost advantage for either drug. The model was also insensitive to the economic effects associated with the risk of accidental needlestick during IM injection. CONCLUSION: over the range of efficacy by the 95% confidence intervals of both drugs, our analysis demonstrated no clear cost advantage for either. The economic effects of accidental needlestick do not change this conclusion. Compared with the IM alternative, oral cefixime is painless to the patient and simpler for the practitioner to administer. Oral cefixime also eliminates the psychologic effects associated with needlesticks in health care workers. For these reasons, we favor the use of oral cefixime for uncomplicated gonococcal cervicitis in adolescents.

Comparison of the efficacy, safety and cost of cefixime, ceftriaxone and aztreonam in the treatment of multidrug-resistant Salmonella typhi septicemia in children.

An increase in the incidence of Salmonella typhi strains resistant to chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole causing enteric fever in Egyptian children stimulated the evaluation of alternative drugs. Children with positive blood cultures were treated with cefixime, ceftriaxone or aztreonam, and the efficacy, safety and cost of these regimens were evaluated and compared. Cefixime (7.5 mg/kg) was given orally twice daily to 50 children for 14 days, ceftriaxone (50 to 70 mg/kg) was given im once daily for 5 days to 43 children and aztreonam (50 to 70 mg/kg) was given im every 8 hours for 7 days to 31 children. Children in the 3 groups were comparable with regard to age, sex, duration and severity of illness before admission. All children were cured. A significant difference (P < 0.05) in duration of treatment before becoming afebrile seemed to favor ceftriaxone (3.9 days) over aztreonam (5.5 days) and cefixime (5.3 days). During the 4-week follow-up period relapses occurred in 3 (6%) children in the cefixime group, in 2 (5%) in the ceftriaxone group and in 2 (6%) in the aztreonam group. Safety and efficacy were comparable for all 3 drugs. Ceftriaxone was most cost-effective on an inpatient basis, because of a more rapid clinical cure, and cefixime was the most cost-effective on an outpatient basis, because of drug cost.

Retrospective analysis of the clinical and economic outcomes of twice-daily dosing of cefotaxime in a Canadian tertiary care institution.

A retrospective analysis of the clinical and economic outcome of a regimen of cefotaxime 1 g given every 12 h was conducted following the introduction of an institutional policy recommending this new dosing strategy. Patients were identified from a log order entry in the pharmacy, and the medical records were reviewed using a standardized data collection form. Explicit criteria were applied for the indications for antimicrobial therapy, presence of infection, and outcome parameters. A total of 60 patients with a mean (+/- SD) age of 56.2 (+/- 17.8) years and a mean (+/- SD) length of stay of 20.75 (+/- 18.1) days were identified. Of these, 48 (80%) were found to have a clinically or microbiologically documented infection, and of the 42 patients who could be assessed accordingly to the criteria chosen, 37 (88%) had a favorable clinical response; 21 patients (35%) received cefotaxime alone. The costs for administration of cefotaxime have decreased by approximately 30% since the introduction of this new dosing regimen.

A retrospective analysis of twice-daily cefotaxime compared to conventional therapy for the treatment of infections in a USA hospital.

A retrospective, matched cohort study was performed to determine the cost outcomes among 495 hospitalized patients who received twice-daily dosing of cefotaxime and 3949 matched cohorts who received other antibiotics. By an attribution model, twice-daily use was associated with shorter mean lengths of stay (-0.498 day, P < .7) and lower mean total costs of hospitalization (-$623, P < .8). Twice-daily dosing of cefotaxime is commonly employed for the treatment of a variety of serious infections, and appears to be cost effective.

Cefotaxime and ceftriaxone use evaluation in pediatrics. Considerations of cost effectiveness.

In 1993, there was a change from ceftriaxone to cefotaxime in the inpatient pediatric division of the Johns Hopkins Hospital. The annual cost savings resulting from this change were estimated. The educational efforts of the pediatric division pharmacists resulted in an increase in appropriate drug selection from 55% to 93%. The estimated annual cost saving was $18,618.

Therapeutic exchange of cefotaxime for ceftriaxone: evaluation, implementation, and subsequent cost savings at a 300-bed community hospital.

Switching prescriptions from ceftriaxone to cefotaxime resulted in a decreased pharmacy expenditure of $30,190 within 1 year in a 300-bed community hospital. The cost per patient day of treatment was reduced from $38.85 to $26.98 and led to a total cost avoidance of $47,997.